Home work Environment, Posture and Postural Stress (Part 2)

Previously we have discussed the implications of an incorrect workstation setup, what posture is and how posture is measured. In this section we will discuss the following:

  • What is ‘poor posture’ and does ‘poor posture’ cause pain?
  • What is postural stress?
  • How do we avoid postural stress?

What is ‘poor posture’ and does ‘poor posture’ cause pain?

‘Poor’ posture is used to describe a person who is unaware of his/her holding a sustained position due to negligence, laziness or habit. For example, sitting in a slump position without moving while one is watching TV for a prolonged period. Another example of ‘poor posture’ is a head forward position that people display as they get older. These postural misalignments have often been scrutinized by healthcare and wellbeing professionals as a potential source of perceived pain.

However, a study published in the Journal of Applied Ergonomics compared 50 individuals, asymptomatic population (people without past or current lower back pain) during three tasks i.e. computer sitting, perceived correct posture and standing for 10 mins. This study finds that slump sitting which is perceived as poor posture by many did not cause pain. (Claus; et al 2016)4

Another common misconception is that people with increased posture or postural misalignment may have musculoskeletal pain, for example, people with a forward neck posture. However, a study which divided their participants (n-120) into four groups according to their age, finds that with increasing age there is also an increase in spinal curvature or posture.  But all the participants in this study were asymptomatic (no history of pain), which means that as we grow older, there is an increase in postural misalignment, but this does not necessarily cause pain. (Chen et al 2017)5

Current evidence indicates that there is no association between posture and pain. On the other hand, people often confuse ‘poor posture’ and ‘postural stress’, and there is evidence which suggests that postural stress does cause musculoskeletal discomfort.

What is postural stress?

Postural stress can be simply put as an awkward position a person may put himself into in order to complete a specific task. For example, picking up a child from a baby cot while the rails are set really high may create abnormal spinal flexion (bending). Postural stress is caused due to poor ergonomics and is not a direct result of ‘postural laziness’6. However, there may be an overlap between poor posture and postural stress. For example, carrying a backpack on one side of the shoulder rather than on your back may cause postural stress to the shoulder and neck muscles. However, if the person changes the backpack from one shoulder to the other frequently, he might avoid postural stress altogether.   

Prolonged postural stress often causes musculoskeletal creep (deformation of viscoelastic properties of a tissue) or stiffness that increases risk of injuries or musculoskeletal discomfort, according to McGill, one of the foremost experts in lower back disorders. (McGill 2015)7

Therefore, the postural stress resulting from bad ergonomics, when ignored and disregarded, causes micro traumas and may later manifest as injuries, for example, occupational overuse syndromes (OOS) or even leading to long term wear and tear of joints such as Osteoartharites (OA).

How do we avoid postural stress?

One of the simplest and most effective ways to avoid postural strains is to move often or alternate between workstations during prolonged sedentary work.

By alternating between our workstations such as conventional sitting, using stand up desks or introducing floor sitting, we expose ourselves to different movement planes and change our work environment, thus reducing postural and physiological stress and risk of musculoskeletal discomfort or pain syndromes.

Below, I would like to share with you how to correctly set up three different workstations, which I call work asanas (sitting postures), that might help you to avoid postural stress caused by sedentary work and prolonged sitting. Here are some ideas for a quick setup of different work asanas at home.

Firstly, conventional desktop setup by converting a dining table to work asana.(Adapted from Mayo Clinic)8
  1. Hip above knees while setting up the chair
  2. Use the back rest, sit back in the chair or use a lumbar roll
  3. Maintain an arm’s length distance between yourself and the monitor
  4. Keep the top of monitor at the eye level, as if looking at the horizon
  5. Keep the keypad in a distance such that your elbows are under your shoulders
  6. Use a mouse pad to maintain the space and postural orientation

Laptop is not ideal for prolonged working, especially at a conventional desk, and it has been proven to be a culprit for causing underlying musculoskeletal stress and repeated strains. Here I will show you simple tips to avoid postural strain.

  1. Raise it to eye level using books or a box
  2. Use a key pad and mouse pad
  3. Chair setup and distance same as setting up the desktop
Secondly, I would like to introduce you to floor sitting

According to Muscles and Meridians (reported by Beach 2010)9, floor sitting has many advantages, such as retuning body-biomechanics and increases postural awareness. It is also one of the most fundamental resting postures used in the early stages of human development. I am going to show you some simple improvisations to make these positions more adaptable with three different postural options. However, please note that this is not suitable for people with hip/knee joint replacements or OA. The three different positions that you may choose from are:

  1. Japanese kneeling posture (use a pillow between hips and knees)
  2. Cross leg posture (use a towel underneath the pelvis)
  3. Side saddle posture (use a towel underneath the pelvis, one hip is internally rotated while the other is externally rotated. Always alternate hips in between sessions)
Lastly, how to set up a sit-stand desk

Standing desks have become a salient feature of the modern-day office setups and many people are familiar with it. Here I will show you some simple ways to convert your kitchen table to a stand-up desk. Laptops are more suitable for a home environment in this particular instance.

  1. When using a laptop – adjust the height by raising it to eye level with some books or a box
  2. Use a keyboard and mouse pad to maintain postural orientation
  3. Some people may use a bar stool for partial weight bearing to avoid standing for too long. However, it is crucial that their feet are planted on the floor so that they are not caught off balance.

Conclusion: “Your best posture is your next posture!” Move often and alternate between different work asanas (sitting postures) when working for long hours to avoid postural stress and muscular discomfort.

References:

1.Kendall, H. O., & Kendall, F. P. (1952). Posture and pain. Krieger Pub Co.

2.Schmidt, H., Bashkuev, M., Weerts, J., Graichen, F., Altenscheidt, J., Maier, C., & Reitmaier, S. (2018). How do we stand? Variations during repeated standing phases of asymptomatic subjects and low back pain patients. Journal of biomechanics70, 67-76.

3.Laird, R. A., Kent, P., & Keating, J. L. (2016). How consistent are lordosis, range of movement and lumbo-pelvic rhythm in people with and without back pain?. BMC musculoskeletal disorders17(1), 403.

4.Claus, A. P., Hides, J. A., Moseley, G. L., & Hodges, P. W. (2016). Thoracic and lumbar posture behavior in sitting tasks and standing: Progressing the biomechanics from observations to measurements. Applied ergonomics53, 161-168.

5. Chen, Y., Luo, J., Pan, Z. et al. The change of cervical spine alignment along with aging in asymptomatic population: a preliminary analysis. Eur Spine J 26, 2363–2371 (2017). https://doi.org/10.1007/s00586-017-5209-

6.https://www.painscience.com/articles/posture.php#sec_stress_vs_poor

7. McGill, S. M. (2015). Low back disorders: evidence-based prevention and rehabilitation. Human Kinetics.

 8. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/office-ergonomics/art-20046169

9.Beach, P. (2010). Muscles and Meridians E-Book: The Manipulation of Shape. Elsevier Health Sciences.

 

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